Vomiting or altered/drowsy: evaluate for shunt malfunction
-look for hydrocephalus
—get rapid sequence MRI instead of CT head (these pts get many, many CTs)
—either may require sedation (etomidate)
-look for kinks in the shunt
—-shunt series (skull xray, cxr, kub)
Fever + irritability: consider shunt infection
-erythema of skin overlying hardware
-other causes: ears, throat, lungs, abd
-labs, blood culture, UA and culture +/- rapid strep and culture
1. Does the shunt need to be tapped?
2. Call NSG (at MMC) vs do it yourself?